Symptoms of stress fractures in the foot and ankle

The symptoms of stress fractures vary widely. The most common complaint is pain. The pain may develop gradually and often is relieved by rest. Pain usually becomes more intense with physical activity and can be associated with swelling. It is rare to see bruising or discoloration.

What are Stress Fractures in the foot or ankle?

A stress fracture is a small crack in a bone, or severe bruising within a bone. Most stress fractures are caused by overuse and repetitive activity, and are common in runners and athletes who participate in running sports, such as soccer and basketball

Stress Fractures usually occur when people change their activities — such as by trying a new exercise, suddenly increasing the intensity of their workouts, or changing the workout surface (jogging on a treadmill vs. jogging outdoors). In addition, if osteoporosis or other disease has weakened the bones, just doing everyday activities may result in a stress fracture.

Reasons to see a physician and treatment options

Consult a foot and ankle orthopedic surgeon as soon as possible if you think that you have a stress fracture in your foot or ankle. Ignoring the pain can have serious consequences. The bone may break completely.

Until your appointment with the doctor, follow the RICE protocol. RICE stands for rest, ice, compression, and elevation.

• Avoid activities that put weight on your foot. If you have to bear weight for any reason, make sure you are wearing a very supportive shoe. A thick-soled cork sandal is better than a thin slipper.
• Apply ice immediately after the injury to keep the swelling down. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly on your skin.
• To prevent additional swelling, lightly wrap the area in a soft bandage.
• As often as possible, rest with your foot raised up higher than your heart.

Nonsurgical treatments

Stress fractures most often occur due to overuse so doctors will likely recommend you limiting how much weight you put on the injured area so treatments include

Modified activities. It typically takes from 6 to 8 weeks for a stress fracture to heal. During that time, switch to activities that place less stress on your foot and leg. Swimming and cycling are good alternative activities. However, you should not resume any type of physical activity that involves your injured foot or ankle-even if it is low impact-without your doctor’s recommendation.

Protective footwear. To reduce stress on your foot and leg, your doctor may recommend wearing protective footwear. This may be a stiff-soled shoe, a wooden-soled sandal, or a removable short-leg fracture brace shoe.

Casting. Stress fractures in the fifth metatarsal bone (on the outer side of the foot) or in the navicular or talus bones take longer to heal. Your doctor may apply a cast to your foot to keep your bones in a fixed position and to remove the stress on your involved leg.

Surgical treatment options

Some stress fractures require surgery to heal properly. In most cases, this involves supporting the bones by inserting a type of fastener. This is called internal fixation. Pins, screws, and/or plates are most often used to hold the small bones of the foot and ankle together during the healing process.

Prevention methods and other tips

The following guidelines can help you prevent stress fractures in the future:

• Eat a healthy diet. A balanced diet rich in calcium and Vitamin D will help build bone strength.
• Use proper equipment. Old or worn running shoes may lose their ability to absorb shock and can lead to injury. In general, athletic shoes should have a softer insole, and a stiffer outer sole.
• Start new activity slowly. Gradually increase your time, speed, and distance. In most cases, a 10 percent increase per week is appropriate.
• Cross train. Vary your activities to help avoid overstressing one area of your body. For example, alternate a high-impact sport like running with lower-impact sports like swimming or cycling.
• Add strength training to your workout. One of the best ways to prevent early muscle fatigue and the loss of bone density that comes with aging is to incorporate strength training. Strength-training exercises use resistance methods like free weights, resistance bands, or your own body weight to build muscles and strength.
• Stop your activity if pain or swelling returns. Rest for a few days. If the pain continues, see your doctor.

Anatomy

Stress Fractures occur when excessive repetitive force is applied to a localized area of bone. Activities such as walking, running, and repeated jumping can subject the bones of the foot to large forces, often leading to microscopic cracks in the bone, called “microfractures.” Normally, the body is able to sufficiently heal these microfractures, leading to a stronger bone able to accommodate these higher forces in the future. However, when the rate of loading on the foot is such that the body’s healing response cannot keep up, a stress reaction can develop. Eventually, if the forces continue, the bone structure can fail and a stress fracture will occur.

Recovery and return to activity

In most cases, it takes from 6 to 8 weeks for a stress fracture to heal. More serious stress fractures can take longer. Although it can be hard to be sidelined with an injury, returning to activity too soon can put you at risk for larger, harder-to-heal stress fractures and an even longer down time. Reinjury could lead to chronic problems and the stress fracture might never heal properly.

Once the stress fracture has healed and you are pain free, your doctor will allow a gradual return to activity. During the early phase of rehabilitation, your doctor may recommend alternating days of activity with days of rest. This gives your bone the time to grow and withstand the new demands being placed upon it. As your fitness level improves, slowly increase the frequency, duration, and intensity of your exercise.